COVID-19 Daily Attestation Form

Everyone must answer the following questions each day before dropping your child off. You may complete it up to 16 hours prior to 8:00 am but no earlier, answers are timestamped. Please note, no one is allowed to enter the school until this form has been completed and verified by staff. Fill out a new form daily for each child attending.


    Today, or in the past 24 hours, have you or any household members had any of the following symptoms:

    Do you have a current or pending COVID-19 test prompted by illness (does not apply to those tested only for travel purposes)?
    A fever (temperature of 100.0F or above), feel feverish, or have chills
    New cough (not related to chronic condition)
    Sore throat
    Difficulty breathing (not related to chronic condition)
    Diarrhea, nausea, or vomiting
    Unusual fatigue
    Headache (not related to chronic condition)
    New loss of smell/taste
    New muscle aches (not related to physical activity)
    Other signs of illness
    In the past 14 days, you have had close contact with a person known to be infected with the novel Coronavirus (COVID-19)
    None of the above

    If the symptoms include, a fever of 100F or above, staff/student cannot return to the program unless they have had at least 48 hours of no fever without taking medication to reduce fever during that time.

    If the symptoms include, any respiratory symptoms (cough and shortness of breath), staff/student cannot return to the program unless it has improved for at least 24 hours.

    By checking this box I agree that the above is true to the best of my knowledge